Cindy Stout

Cindy Stout, CEO, El Paso Children’s Hospital

Q&A presented by TexasMutual

It’s been nearly 10 years since El Paso Children’s Hospital welcomed its first patients on Valentine’s Day in 2012.

The ride since then hasn’t always been smooth. There have been financial troubles, staff departures and lawsuits at El Paso Children’s. But Cindy Stout, the hospital’s CEO, still believes El Paso Children’s provides hope for families across the region.

Over the past decade, there have been more than 150,000 patients treated at the hospital. Stout said they have decreased the number of families who have to leave El Paso for treatment dramatically, by 84%.

Stout, who earned a doctorate in nursing practice from Duke University, has 20 years of previous experience at Del Sol Medical Center, where she was chief nursing officer for 10 years. She then was chief nursing officer at University Medical Center of El Paso before making the transition to El Paso Children’s in 2017.

The hospital had emerged from a seven-month bankruptcy in May 2016, and she was the hospital’s seventh chief executive in the five years since it had opened.

Stout sat down with El Paso Inc. last week on the eighth floor of the hospital. She talked about major wins at the hospital, how treatment has changed over her career and what’s the next step for El Paso Children’s.


Q: A lot has happened since El Paso Children’s opened almost a decade ago. What are some of the biggest changes and how is it going now?

We’re really excited to reach the mark of a 10-year anniversary. It’s a big deal for the hospital and not just the community. The hospital went through a bankruptcy, some reorganization, that was back some years prior to my arriving.

Yesterday was my four-year anniversary. I can’t believe how quickly time has gone by. I look at the mission of what this hospital was meant to be, and it was to keep the kids here in El Paso.

I’ve been in health care in El Paso for over 30 years. We have long known the types of patients that have to leave the community for care. We’re too big of a city and region for that to really be something that should take place.

Since the hospital opened its doors on Valentine’s Day in 2012, we’ve been able to decrease the number of children who leave the community for care by 85%.

We are one of seven hospitals that participate at the state level with the dedicated not-for-profit children’s hospitals. This next year, I’ll be serving as the chair for the Children’s Hospital Association of Texas. It affords us that platform for us to understand and continue to see how cities and metroplexes have developed their specialized children’s care.

We have a number of different programs. For instance, our oncology program has been a game-changer for this region. I say that because you want to make sure that kids have the best care for oncology so that they don’t have to leave the region.

My background is nursing, and my clinical background is oncology nursing. One of the things I’ve been sensitive to, and knowing as a mom myself, it’s hard when a family has to pick up and leave the city to go for care elsewhere.

The number of kids we’re able to treat now specifically for cancer care is a tremendous benefit to the community. With children being home, they have access to their families being here, their friends. Socialization is really important for children.

We have a neonatal intensive care unit. It’s the highest level you can achieve in Texas, a Level 4 program. We can take care of the smallest baby that comes through, and the only way we can do that is by making sure we have all the subspecialties available.

That’s one of the things the hospital has brought to the forefront, especially with our relationship with Texas Tech. For instance, we have three general surgeons that practice here at the hospital. We also have a very strong craniofacial program, one of nine internationally that has a fellowship program.

With the level of care we provide, we get children from all over the world – South America, the Middle East, from Europe.

I was brought on board four years ago, post-bankruptcy. At that time, the hospital was losing $16.5 million a year. That’s not sustainable for any organization.

I had very clear direction that I needed to implement quickly to get the hospital back to where it needed to be in a positive perspective.

We were able to decrease that loss, and it was in fiscal year 2019 that we moved to a positive position of $3 million. The following year we continued to double that, and this year we’re projecting to come out looking pretty good.

El Paso Children’s Hospital does not receive taxpaying dollars. It means we have to be efficient, to be smart, as we grow programs.

Q: What’s the status of the hospital’s debt repayments to UMC?

When I came on board, we recognized that there were some debt obligations that needed to be paid off. We’ve paid off everybody that we owed money to, and continue to pay UMC. But everybody else is paid off.

We had a debt we had to pay to Texas Tech, that was completed close to two years ago. We kicked right into paying UMC. We did have a line of credit initially to help the hospital get started and get back into a positive position.

That line of credit has been paid. The long-term debt that’s a result of the bankruptcy, we also have that situated out where we’re going to have to pay that out as well. But we’re up current on all the payments.

Q: How’s it been in terms of employment at the hospital, bringing in staff, doctors, nurses and support staff?

Every hospital has experienced something very similar, especially during the pandemic.

We’re fortunate that a lot of the children in our region did not get critically ill. I think part of that was because our region took the stance on how important it was to push immunizations, make sure people were wearing masks even outside their homes and when going to different venues.

That’s a kudos to our county judge Samaniego as well as our mayor. That’s afforded us the opportunity for children not to be so critically ill.

On the opposite side, especially in the first 12 months, a lot of children were at home. Then you’re looking at issues where perhaps they didn’t have that same stability in terms of socialization. We are seeing more children now that have anxiety and depression. That’s of concern to us.

Going back to your question about the workforce, with us having not as many critically ill children we were able to stabilize our staffing.

Now what’s different is nurses are being offered large amounts of money to go to programs that are supported through FEMA or other types of programs right now that typically weren’t in place.

It affords them an opportunity to make much more money. I meet with the other local hospital CEOs; we’re all experiencing the same issue. And it’s happening nationwide as well.

We’re doing everything we can to make sure our teams feel appreciated, that our teams understand that we value and respect the work they do. Being in a specialized children’s hospital, these staff members are highly trained. It takes oftentimes years to get to that level of training. We continue to work to try to make sure we retain our staff members, that we’re recruiting the best staff members coming in.

Q: Who are the patients you’re seeing at the hospital, in terms of illnesses?

The main diagnoses we’re seeing are respiratory illnesses and gastrointestinal illnesses. That’s not unlike what we typically see around this time of year. However, what’s a little bit different is that we’re seeing it earlier in the season than we typically do.

The weather is not cold outside. It’s usually when things start to turn cold that you see more of these respiratory illnesses going around. We have conversations with our physicians about what we think is stimulating that.

Part of it we hypothesize is that it could be we’ve had our kids isolated for so long, No. 1. No. 2 is that with the mask, with all the handwashing they’ve been so great doing, is that you’re limiting the number of germs, and your immune system is not completely stimulated.

With that being said, we’re seeing much earlier in the season these respiratory illnesses. Nationwide, a lot of children’s hospitals are dealing with RSV. With that one, it can be contagious and is typically in very young children.

Right now, we’re fortunate that our region is not experiencing the high volume numbers that other big cities in Texas are experiencing.

Q: What has the COVID response looked like at the hospital?

Wince the pandemic started, we’ve tested on-site over 5,400 children. Based upon that number, only about 14% of those patients came back positive. It’s a pretty low number.

In that 14% that came back positive, only 13% required admission. That’s where you see that difference between the adult population and children. Children are pretty resilient. There’s something about how this virus attacks our bodies, and there’s so much that has to be learned.

In this particular component, very few require admission. The vast majority are not highly acute and do not require the pediatric intensive care unit in our region.

We’ve been fortunate and have been able to manage that volume and our children have done overall very well.

Q: How is El Paso Children’s relationship with Texas Tech and the pediatric residency program?

Our commitment is steadfast with Texas Tech. I meet on a weekly basis with Dr. Richard Lange (president of Texas Tech University Health Sciences Center El Paso). We talk through program growth and development, where we’ve been, what are the processes we want to put in place, what are the things we can continue to do to better patient care for all children, and what we can do to help continue to create that pipeline of residents coming through.

Ultimately, the goal of the region is to have enough providers to where you don’t have a provider that’s overwhelmed with too many patients.

We’re steadfast in our relationship with Texas Tech, that is a long-term relationship for us. We cannot provide a lot of our subspecialties without them.

That being said, when the hospital opened its doors, it was always an open medical staff. Physicians from the community always practiced here. Not always to the level and numbers with which they do now, but they did before.

Our residents continue to rotate through – they do through all our departments, whether it’s the emergency department, pediatrics, pediatric intensive care unit, neonatal intensive care, the list goes on and on. Pretty much every place within the hospital, they rotate through.

Q: How have the treatment options changed through the years, especially in areas like pediatric oncology?

When I started 30 years ago, I don’t want to say it was limited with the number of treatment plans, but it wasn’t diverse as it is now.

There are a lot of different modalities for cancer patients that weren’t in place when I was practicing. Back then, I remember them barely talking about immunotherapy and just starting with that. That’s a run-of-the-mill thing we do for children nowadays.

The advancements you get in the different types of chemotherapeutic drugs, or the treatment plans for radiation oncology, all of those things we had back then but we didn’t have them to the extent we do now because so much research has been done.

Q: We’ve previously reported on lawsuits El Paso Children’s is facing, including a wrongful death lawsuit filed by El Paso businessman David Saucedo and his wife after the August 2019 death of their 3-year-old daughter at the hospital. Can you comment on that lawsuit or others?

Let me first and foremost say, because I’m a clinician and a mom, it’s difficult anytime a family loses a child. It’s one thing when you lose an adult, but it’s even more difficult when you lose a child. Our sympathies are with that family.

This is a case that’s in active litigation. I can’t say as much as I’d like to say, but what I can tell you is that I’m confident with the care that is being provided for the children of the hospital.

We recently went through our Joint Commission survey. We walked out of that with full accreditation. We’ve had other entities that have come in to survey the hospital and have done extremely well.

I’m really proud of the care that’s been given by our physicians and staff members. We wouldn’t be receiving good accolades on these surveys if that level of care wasn’t where it needed to be.

People may ask, why isn’t the hospital saying something? There are federal laws we have to follow. With HIPAA, there are laws with which we cannot discuss patient information. But I think that overall the level of care that’s being provided at this hospital is something to be proud of.

Q: We’ve previously reported about concerns raised by some nurses at the hospital and by six community doctors in letters. Among the concerns is the hospital’s abrupt decision last year to have Dr. Robert Canales take over the operation of the pediatric intensive care unit from Texas Tech. In the end, Children’s allowed both groups to operate in the PICU, but can you address those concerns?

Dr. Canales has privileges here at the hospital, just as many other pediatricians in the community have privileges. One of the things I can tell you is you have to have a review process in place. We have a strong process and I am very confident with the level of care that’s being provided not just by Dr. Canales but all my physicians who practice here in the hospital.

One of the things is that, when the hospital was initially formed, the analysis that was done for the hospital was that this hospital has to be supported by the whole community.

I look at it simply as this: If we’re delivering the highest level of care in the region for children, why would we not want every physician to come practice at this hospital? Because ultimately what happens is all those physicians have access to all these specialists here at the hospital, unlike any other hospital in the region.

That’s kind of this transition that’s happening, is that more and more physicians are taking notice of the level of care that’s being provided here. They’re going to take advantage of bringing more of their patients here, and that’s what we want. I would want that as a mom, for my child to go to the highest level of care.

Q: Could you talk to me more about the hospital’s process for choosing who to bring on board?

Physicians have to apply for privileges at any hospital with which they choose to see patients at. That’s a routine basis across every single hospital. Everybody that also has a Joint Commission accredited hospital has to have all of these medical staff processes in place.

Once you go through and put your application in, it is reviewed through a background and resource check. From that point, that application starts going through different physician committees. The physician committees are the ones that give the approval for other physicians to practice at the hospital.

The executive team, I myself, cannot make decisions on which physicians practice at the hospital. It’s governed by doctors themselves.

Q: Are you able to comment on the statement from Dr. Tom Mayes where he alleges he’s been pressured or coerced to sign off on approval for Dr. Canales’ privileges in the pediatric intensive care unit?

What I can tell you is the appropriate credentialing process was followed, for Dr. Canales and every other physician that’s come into this hospital. Nothing was deviated from for any physician to my knowledge who’s come into our facility.

Q: We’ve also reported on departures at the hospital, including the former CFO and HR director.

In terms of our CFO, I’m very proud of Melissa Campa and the work she did with our hospital. She left because she had another opportunity to grow. This was her first CFO experience being at the hospital. I encourage people to grow.

Somebody opened the door for me to grow and develop as a leader, and that’s my commitment with my team too. When Melissa got the opportunity to go to a larger hospital, absolutely I’m going to support her with that.

Our human resources director had an opportunity also to take a position at a larger facility, is what she shared with me. We’re excited for her. She had been here for a significant period of time.

As a professional, each person had to determine where they wanted to be. Those are not individuals that left on bad terms.

Q: Moving forward, what do you foresee as some of the challenges that El Paso Children’s might face?

Our biggest challenge right now is capacity. The hospital has outgrown its space. It’s a beautiful problem to have, but it’s a challenge. You have to be able to manage the patients you have in-house, and how do you keep that door open to continue to get more patients coming through.

We have an eighth floor that’s a shell right now. Our goal is to open that up and have additional pediatric beds and an intermediate care unit, so that we can take care of children but we can also put them on monitors, where maybe they’re not appropriate for pediatric intensive care, but can be in a stepdown unit.

In that case, I’m working very closely with Jacob Cintron at UMC because this building is ultimately owned by UMC, and we pay that lease to UMC and they’re going to help us build out that specific unit.

The other challenge is continuing to bring in more subspecialists to the city. We’ve been very fortunate, and Dr. Lange has been great to work with. He’s got a whole list of physicians he’s trying to recruit to the city. But it’s difficult because so few graduate from those specialized programs and everyone in the nation is competing for the same talent.

The other big thing is figuring out that 15% (who leave town for care). We know it’s complex cardiac service and complex neuroscience services. We’re trying to close those gaps.

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